Alcohol, Drugs and Violence Between Intimate Partners

Intimate partner violence (IPV) refers to verbal, psychological, and/or
physical violence between two members of an intimately involved couple.

A study has found that female and male alcohol-related problems, as well
as female drug use, are associated with an increased risk of moderate and
severe male IPV (where the man is the perpetrator).

Living in high-unemployment neighborhoods also increases risk for severe
male IPV.

As a disturbing sign of the times, perhaps, or because of a search for clarity,
the term "domestic violence" no longer means - as it was first coined
30 years ago - husband-to-wife violence. The term now encompasses all types
of violence in the home, including spousal violence, elder abuse, and parent-to-child
violence. Intimate Partner Violence (IPV) has become the subset of domestic
violence that refers specifically to the verbal, psychological, and especially
physical violence between two members of an intimately involved couple, married
or unmarried. While research indicates that female IPV (where the woman is the
perpetrator) occurs as often or even more often than male IPV (where the man
is the perpetrator), women are more likely than men to sustain injuries and
need medical care as a result of IPV. A study in the April issue of Alcoholism:
Clinical & Experimental Research examines associations among male and female
alcohol problems, drug use, and risk of IPV in a general household population
sample.

"Our key findings were that female and male alcohol-related problems,
and female drug use, were associated with an increased risk of moderate and
severe male IPV," said Carol B. Cunradi, epidemiologist, associate research
scientist at the Pacific Institute for Research and Evaluation, and lead author
of the study. "In addition, couples living in high-unemployment neighborhoods
are at increased risk for severe IPV compared to couples living in low-unemployment
neighborhoods, even after statistical adjustment for other factors."

"Not surprisingly," added Roland S. Moore, a research anthropologist
at the Pacific Institute for Research and Evaluation, "men and women who
had been victims of childhood violence were more likely to be involved in severe
male-to-female partner violence. In contrast, and similar to those couples who
lived in neighborhoods with low unemployment, White and Hispanic couples were
also less likely to engage in male-to-female IPV."

Researchers examined a multiethnic sample of 1,615 married or cohabiting couples
from the 1995 National Study of Couples, a cross-sectional study of alcohol
and IPV that was part of the ninth National Alcohol Survey. The sample included
555 white couples, 527 Hispanic couples, 358 black couples, and 173 couples
of "mixed" ethnicity. Participants were asked about sociodemographic
and psychosocial variables, as well as alcohol problems, drug use and IPV during
the 12 months prior to the interview. In addition, neighborhood unemployment
data were collected for each couple from the 1990 census.

Although alcohol-related problems and, to a lesser degree, drug use were associated
with an increased risk of male IPV, this does not necessarily mean that high
levels of alcohol consumption will cause more IPV. In fact, alcohol-related
problems (such as withdrawal or negative social consequences) rather than heavy
alcohol use might prove more relevant when examining IPV.

"Alcohol-related problems indicate a loss of control over drinking that
mirrors loss of control in other aspects of life," said Moore. "Such
loss of control in relationships can lead to more unstable situations in which
intimate partner violence is more likely." In other words, lack of restraint
regarding alcohol may be part of a larger problem that includes aggressive or
violent interpersonal exchanges, which can collectively lead to discord and/or
fighting.

"The neighborhood unemployment association that we found," said Cunradi,
"is part of a growing body of literature examining the association between
neighborhood factors or characteristics and various health outcomes or behaviors.
We don't know why characteristics of the neighborhood are associated with greater
risk for severe male IPV. One can certainly speculate on the emotional/psychological
sequelae of residing in a high-unemployment neighborhood. Given that men are
still expected to be the household breadwinners, living in such a neighborhood
may be associated with feelings of depression, powerlessness, stress, etc. These
factors, in turn, may provide a toxic atmosphere for the resolution of conflict
between the couple; violence may ensue."

Moore concurs. "In a society where status and self-worth have been closely
tied to one's work, people with fewer opportunities for work face frustration
and depression, not to mention stress over providing basic resources for the
household. These negative emotions probably foster conflict, including a greater
likelihood that violence will ensue."

Both Cunradi and Moore said that although this study finds an association between
IPV and substance use or abuse, it does not clarify which comes first.

"A person engaging in heavy drinking or other forms of intoxication certainly
increases their odds of being victimized," said Moore. "And 'self-medication'
through heavy alcohol or drug use may be a response to the traumatic experience
of being victimized. The direction of causality in some of the associations
discussed in this paper could be better established with longitudinal studies:
an expensive but worthwhile goal."

Cunradi said this was next. "Although the National Study of Couples was
originally conceived as a cross-sectional study," she said, "additional
funds were obtained to re-interview the participating couples during the year
2000. The data obtained from those interviews are currently being analyzed and
may provide insight into which factors may be causally related to IPV, and predict
its occurrence over time."

"It's important to remember that IPV is a difficult topic to study because
it usually takes place behind closed doors," said Moore. "Moreover,
it is not an easy topic to talk about. The association between alcohol and other
drug use and IPV is common knowledge, but there are relatively few studies examining
the links between them in a sophisticated way. Certainly detailed analyses of
intimate partner violence and substance use such as this are relatively rare."

Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.